11-month-old’s partial heart transplant makes history in Texas. How doctors did it

Elias Robinson-Rodriguez’s life has been challenging since it began.

Born in 2022, the 11-month-old boy has a congenital heart defect known as transposition of the great arteries.

The condition obstructs his heart’s valves, the pumps that push blood throughout his body. The valve between his left heart chamber and his aorta, the body’s main artery, wouldn’t fully open, blocking blood from moving out of his heart.

Often diagnosable during pregnancy, the condition occurs in 1 out of every 3,413 babies born in the United States each year, according to estimates from the Centers for Disease Control and Prevention.

For Elias, his condition meant he spent the first months of his life struggling to breathe and eat, feeling a pounding in his heart and with a bluish tint to his skin.

The only option for help was an incredibly rare partial heart transplant, completed only six times anywhere in the world.

On June 23, doctors, surgeons and researchers from UT Health Austin and Dell Children’s Medical Center successfully completed Elias’ partial heart transplant, according to a July 10 release.

A milestone procedure

A “typical” heart transplant takes the entire organ out of one person and surgically implants it in the body of another, according to the Mayo Clinic. Surgeons then connect the major arteries from the recipient’s body to the donated heart, and the heart will typically start beating again when blood flow is restored.

For children with congenital heart conditions, like Elias, they won’t survive without a new or adapted heart. But since they are so young, they need a heart that can grow with them, and not an adult heart that will disproportionately fit in their bodies.

Surgeons started to search for another solution.

Studies that showed the successful transplant of living tissue heart valves in pigs caught the eye of Joseph Turek, a pediatric heart surgeon at Duke Health, according to a September 2022 release.

Turek had a patient with the same condition at Elias, 17-day-old Owen Monroe, who would likely not have survived if he waited for a heart on the transplant list.

In 2022, for the first time ever, Turek transplanted healthy, living heart valves from a donor heart into the struggling heart of Owen — and it was a success.

The procedure was done successfully five more times before surgeons decided it was the best course of action for Elias.

“This is a milestone procedure, a partial transplant allows surgeons to tap into a supply of donor hearts that go unused due to deficiencies. We are thrilled with Elias’ progress and we are hopeful this will eliminate the need for future surgeries,” medical director of the pediatric heart failure and transplant program at Dell Med, Chesney Castleberry, said in the release.

Change the surgery paradigm

Elias’ success could mean there is more hope for other children with his condition.

“Our team is excited about this procedure, it has the potential to change the paradigm of valve surgery in pediatric heart disease,” director of the heart transplant program at Dell Children’s, Carlos Mery, said in the release. “This potentially life-saving surgery can make use of a donated heart that would otherwise not be transplantable.”

Children who are waiting for a heart transplant face the highest rate of death out of any group on the organ donation waiting list, according to a 2009 study published in the cardiology journal Circulation.

If surgeons are able to transplant healthy valves out of hearts that would have otherwise been deemed “not transplantable,” the wait times for heart transplants could greatly decrease, and the number of children who could have healthy hearts would go up.

“This groundbreaking surgery provides hope for thousands of babies with congenital heart defects and amplifies the way we can use the gift of organ donation to save more lives,” chief of pediatric and congenital heart surgery at the Texas Center for Pediatric and Congenital Heart Disease, Charles Fraser, said in the release.

As for Elias, the surgery team is optimistic about his progress following the 11-hour surgery.

“Elias is showing remarkable improvement and his outlook remains strong. This was the third open heart surgery for Elias,” the release said.

His surgery took place in Austin, Texas.

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